Institute For Healthcare Improvement’s

100k lives Campaign

Clint MacKinney, MD, MSclintmack@cloudnet.com

Duluth, MinnesotaJuly 19, 2005

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Topics for Today

1. The 100,000 Lives Campaign

2. Why is the Campaign important

3. Why rural and why us

4. The Campaign’s current status

5. The interventions

6. Resources to get started

7. Opportunities and barriers to involvement (discussion)

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A Flawed System

“Between the health care we have and the health care we could have lies not just a gap, but a chasm.”

– Crossing the Quality Chasm, 2001

Health care does not yet reliably transfer best-known science into practice, and processes frequently fail, despite the best intentions of a dedicated and highly skilled workforce. Our system, which intends to heal, too often does just the opposite – leading to unintended harm and unnecessary deaths at alarming rates.

– 100k Lives Campaign folder, 2004

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Background

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Six Changes that Save Lives

1. Deploy Rapid Response Teams*

2. Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction (Heart Attacks)*

3. Prevent Adverse Drug Events (ADEs)*

4. Prevent Surgical Site Infections*

5. Prevent Central Line Infections

6. Prevent Ventilator-Associated Pneumonia

*Rural-appropriate interventions

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Healthcare Safety?

•< 98,000 deaths per year due to medical errors

– Institute of Medicine, 1999

•195,000 deaths per year due to medical errors – HealthGrades, 2004

•How many is too many?

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Healthcare Quality?

The Quality of Health Care Delivered to Adults in the United States – McGlynn et al

Results •Participants received 54.9% of recommended care.•45% defect rate!

Conclusions •The deficits we have identified in adherence to

recommended processes for basic care pose serious threats to the health of the American public.

NEJM. Volume 348:2635-2645. June 26, 2003. Number 26

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Healthcare Value?

30%

70%

Costs of PoorCare

AppropriateHealth CareCosts

Causes of poor care: Misuse, underuse, overuse, waste – Juran Institute and Midwest Business Group on Health. 2003

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Why Rural; Why Us?

•30% of Minnesota’s population is rural

•The “big” systems have already signed on

•Our interest in improvement, and our need for improvement, is no less significant

•Our patients, families, and communities are no less cherished

•Only interventions that make sense for rural, for our hospitals, and for our communities

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If not for statistics, then for our future

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Participation May 2005

•Over 2,200 hospitals enrolled in all 50 states

•Nearly 50% of U.S. hospital beds

•Thousands on national calls

•Unprecedented web activity and new tool development

•Related campaigns forming globally

•Data collection underway with Pioneer Group; begins for all enrollees 6/14/05

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Participation May 2005

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Changes Proven to Prevent Avoidable Death

•Rapid Response Teams– Cardiac arrest or shock

occurs in 0.6% of medical patients and 0.5% of surgical patients.

– Only 17% of patients who experience a cardiac arrest survive to discharge.

– Most patients who have in-hospital cardiac arrest have identifiable signs of deterioration prior to arrest.

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Changes Proven to Prevent Avoidable Death

• Improved Care for Acute Myocardial Infarction– 1.1 million experience an

AMI yearly. 1/3 die acutely.– Implementation of

guidelines reduces mortality.

– Yet in AMI, only 61% receive aspirin and only 45% receive beta-blockers.

– AMI care included in • CMS’ Hospital Quality

Initiative, • JCAHO’s core measure set.

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Changes Proven to Prevent Avoidable Death

•Prevention of Adverse Drug Events– 1,200 hospital deaths in

1993 were due to medication errors.

– 6.3% of malpractice claims are due to medication errors.

– 46% of all medication errors occur at care transition points.

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Changes Proven to Prevent Avoidable Death

•Prevention of Surgical Site Infection– Surgical site infections

(SSIs) account for 14% - 16% of hospital-acquired infections.

– Among surgical patients, SSIs account for 40% of hospital acquired infections.

– Surgical patients who develop SSIs are twice as likely to die as other surgical patients.

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Changes Proven to Prevent Avoidable Death

•Prevention of Central Line-Associated Bloodstream Infection– 48% of ICU patients have

central venous catheters, or 15 million catheter days per year.

– There are 5.3 venous catheter-related bloodstream infections per 1,000 catheter days.

– Approximately 14,000 deaths per year from venous catheter-related bloodstream infections.

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Changes Proven to Prevent Avoidable Death

•Prevention of Ventilator-Associated Pneumonia– Ventilator-associated

pneumonia (VAP) occurs in 15% of patients receiving mechanical ventilation.

– Mortality for mechanical ventilator patients with VAP is 46% compared to 32% for those without VAP.

– VAP is associate with prolonged mechanical ventilation, ICU stay, hospital stay and associated increased costs.

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Resources – IHI

•www.ihi.org/IHI/Programs/Campaign/ – Platform materials for each intervention

• How-to Guide for implementing the change• Presentation with facilitator notes• Annotated bibliography

– Campaign activity checklist– Getting Down to Work: Field Operations,

Implementation, Measurement, and Next Steps– Customizable press release– Data submission how-to guide– Multiple informational calls, videos, web

discussions

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Resources – Minnesota

•Minnesota Node – 60-70 hospitals signed on!– Stratis Health (Minnesota’s QIO)

• Acute Myocardial Infarction, Adverse Drug Events, Surgical Site Infections

– Institute for Clinical Systems Integration• Rapid Response Teams, Central Line Infections

– Minnesota Hospital Association• Ventilator Associated Pneumonia

•Contact– Julie Apold, MHA Patient Safety Manager– japold@mnhospitals.org

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Resources – www.mnpatientsafety.org

The Minnesota Alliance for Patient Safety was established in 2000 as a partnership between the Minnesota Hospital Association, Minnesota Medical Association, Minnesota Department of Health and more than 50 other public-private health care organizations working together to improve patient safety.

"Promoting optimum patient safety through

collaborative and supportive efforts among health care

organizations in Minnesota"

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Some Is Not a Number… Soon Is Not a Time

The Number: 100,000 Lives

The Time: June 14, 2006

9 am ET